Patients and friends, and even counselors and spiritual advisors, have for decades urged me to write publicly about my experiences dealing with bullying. Here is a condensed excerpt from my journals, files and class notes with the intent of increasing some awareness and hope around this subject:

Bullying is not only a serious problem, it is deceptively complex. As a result, it is not so easy to understand bullying problems or to determine how to respond to them. Throughout my life, I've been surprised how few family members, peers and patients seem to understand what I'm going to explain here. I think it is important to address bullying because it is pervasive and accompanied by detrimental and often subtleeffects that linger long after the episodes end. The stories of bullying extend beyond the children, adolescents or adults who bully or are bullied. Cultural considerations, family and peer interactions and individual features all contribute to bullying.

Common in the schoolyards, homes and workplaces for decades, bullying has been a predictable, "accepted," usually not discussed although painful, part of people's lives, young and old. It has been said that bullying is "the most prevalent form of low-level violence in schools and homes today". (1) Until very recently, bullying has been tolerated in western society, and school-based and home bullying was considered a "normal" part of childhood/adolescence that had a possibly good outcome through "character-building." Although some people still see it that way, possibly because of how pervasive bullying is in the school and home context, bullying has recently been recognized as a public health problem that needs to be addressed.

DEFINING BULLYINGBullying is defined mainly as a form of aggression that can be direct or indirect, and that includes physical, verbal, or psychological and relational acts, that is intentional and occurs in a relationship characterized by a power imbalance and that is repeated over time. (2)

Regardless of the form it takes, bullying is a type of aggression that damages a person's sense of self or their peer/family relationships. Overt aggression can be physical or verbal and include hitting, pushing and making verbal threats or put-downs. Many of us were taught to accept put-downs as a way to maintain family hierarchy, and to resist would be futile. While covert or indirect aggression is considered a form of bullying, some hurtful forms of behavior such as exclusion ("you don't belong at the top of the totem pole with us because you don't support our "better-than-you", greedy, judgmental, domineering values") and gossip ("He's not as motivated by these values as we are.") are often omitted from the definition, making it possible for some types of bullying to be overlooked or considered acceptable. The fact that indirect bullying is so prevalent perpetuates the view that it is both normal and harmless, while in fact this is very much not the case. (3)

Research shows that high peer or family status is associated with increased aggression toward peers or family members.

Most parents and teachers actually believe that physical aggression is more serious than verbal or indirect aggression, and don't try to intervene! Personally, the persistent shaming I endured in my first 30 years finally became tolerable. Now, the people I trust enough to hang out with never shame me. If they did, they would feel remorse and try to stop. Narcissistic bullies who lack empathy and rarely feel remorse are unable to change, so resolution never happens. In fact, when confronted about it, narcissistic bullies blame their victim for being "too sensitive."

Researchers see bullying as a "destructive relationship problem" in which the bully is addicted to using power/domination and intimidation to control and distress others; younger victims feel increasingly powerless to defend themselves from this peer or relationship abuse. (4)

The power over others that bullies seek can result in social advantages such as a dominant social role (e.g., a teacher compared to a student; a doctor compared to a patient; a counselor compared to his/her client; an older sibling compared to a younger sibling whether they are adults, adolescents or children). The patterns of domination or superiority behaviors are often lifelong. This power-over-others behavior is commonly expressed through systemic power (e.g., racial or cultural groups, sexual minorities, economic disadvantage, disability).

Power can also be acquired by knowing another individual's vulnerability (e.g., younger age, smaller size, lower family status, health problems, family background) and using that knowledge to cause distress.

Whether or not repeated incidences of an aggressive behavior need to occur for it to be considered bullying is controversial. Why? Because repetition may involve actual repeated bullying incidents over time, or even thefear and anxiety about the possibility and unpredictability of future bullying incidents that can be triggered by a single bullying incident!

EFFECTS OF BULLYINGBullying can seriously affect the academic, social, emotional, and psychological functioning and physical health of people who are victimized and who bully. Children who are bullied tend to suffer from internalizingproblems such as depression and anxiety, whereas those who bully are more likely to experience externalizing problems such as aggression, temper tantrums, domineering and attention-seeking behavior.

Being a victim of bullying is associated with more mental health problems (including PTSD), and including more stress-related physical symptoms like headaches and gastrointestinal problems, even insomnia. Many studies have shown that bullying leads to increased risk for suicide among children, adolescents and young adults. Altered sympathetic nervous system responses (exaggerated "fight or flight" feelings) with elevated cortisol levels (very destructive) and elevated blood pressure are part of this victimization history.

Victimized people describe themselves as "unsafe" around "arrogant know-it-alls" and report heightened sensitivity to the bully's apparent lack of empathy or "lack of heart." A bully's need to be the center of attention or the need to feel like the most important/most deserving person in the room is perceived by an alert victim as a "danger ahead" sign. (5)

Boys in grades 6 to 9 who bullied were about 4 times more likely to become expert verbal/psychological bullies in adulthood. (6)

PERSONALITY TRAITSBullying children and adolescents are often depicted as being stronger than their peers, assertive and often "popular socializers." These kids appearconfident, and people confuse their false self-esteem for true self-esteem. People with false esteem depend on others' outside validation or adoration to feel good/confident. True self-esteem is about a person looking in the mirror and evaluating what is truly inside them:1. How much have I tried not to hurt others feelings?2. How responsible have I been about valuing others equally?3. How honest have I been, including about the first two questions?As noted earlier, bullies are at higher risk of developing lasting problems, including especially narcissism, which often signals the end of spiritual awakening/understanding.

NOTE ABOUT FAMILIES AND SIBLINGS WITH BULLIESFamilies with a bullying child, usually the oldest, biggest child, have been described as having certain characteristics. There is an association between bullying and poor family functioning, with authoritarian or punitive parenting. Families of a child who bullies often lack genuine warmth and have a lot of conflict or violence. Often alcoholism and depression are in one or both parents. Rates of relational aggression between siblings increase when parents show high degrees of negative affect (mood) along with low levels of parental warmth and involvement. At the same time, the child who is lower in status ("you are beneath us on the totem pole," I was repeatedly reminded) becomes trapped and feels increasingly unable to escape or change the situation. The child who bullies is reinforced by feelings of power and inclusiveness. He/she will not, understandably, relinquish this power-over-you position and will punish those who confront the injustice - a no-win situation for the person lowest on the totem pole. Again, this situation is hopelessly unchangeable when the parents and the bullying siblings are all narcissistic! Do you still wonder why there is terrorism in humanity/inhumanity?

WORKPLACE BULLYING42% of American workers report having been bullied at work! Approximately half of working adult Americans reported being negatively affected by bullying.

Half of the workplace bullying takes place in front of witnesses, with males bullying more publicly than females. The majority of bullies are men (60%), and the majority of victims are women (57%).

Women target women 71% of the time, which is 2.5 times as frequently as they target men. Men bully other men and women equally.

Bullying is 4 times more prevalent than illegal, discriminatory harassment. Often, it is the bullies rather than the victims who threaten employers with lawsuits to put a stop to investigations or attempts to curb the mistreatment. In 62% of cases, when employers are made aware of bullying, they escalate the problem for the victim or donothing! When nothing is done, the employer becomes the bully's accomplice, either deliberately or inadvertently, by allowing the bullying to continue. Employers offer help in less than one-third of these situations. I recently had to fire an office manager who bullied a coworker and some patients, and who stole from me, and now acts like a victim! These people can be very intimidating and deceptive, reasons why they often don't get fired soon enough, before greater damage is done.

Unlike school-based and home-based bullying, when adults are needed to intervene and stop the bullying, the adult victim of bullying is the one with the primary responsibility for finding a solution to the problem.

While on occasion someone who was bullied at the workplace may behave violently, it is more common for those who are bullied to direct the violence inward and commit suicide.Depression is common. Of the 20 patients of mine who have committed suicide in the past 23 years, 18 were victims of bullying, mainly from family members but also from the workplace in 9 of those cases. Interesting also is that 16 of those had refused care for the resulting depression/anxiety/insomnia.

CONCLUSIONBullying, at all levels, is a complex phenomenon. It can start as early as preschool and continue throughout elementary school, high school and college. It can occur in the context of the workplace and the family, especially when narcissistic bullies feel powerful and entitled. Bullying is always damaging to both the bully and the victim. When it happens to children, it can impair normal development and healthy, true self-esteem, and make the experience of going to school (or going home) a miserable one. When it happens in the workplace, it can destabilize the entire family and threaten an individual's livelihood and career.

Adults need to involve themselves in stopping the bullying of children. Don't assume that you will be able to recognize a bullying victim by his or her behaviors, as a bullied child's behavior and characteristics can vary. Don't assume that you will see the situation in the same way as the child who is being bullied; take care nottominimize the child's experience or discount their perception. Listen supportively, showing empathy. If you can't do that, you may be a narcissist who attempts to fake empathy. Don't! The victim will know when you are trying to fake empathy and "play nice."

With adults who are being bullied in the workplace, don't intervene directly on their behalf unless you are in a position of power over the bully. Instead, listen supportively and encourage the victim to deal with the situation directly. Show real empathy and appreciate the victim's point of view. Help the victim see that they can handle the situation themselves or encourage them to go to the appropriate sources for assistance. (7)

My counselors and spiritual advisors have always unanimously urged me to "get off and stay off the bully's game board and don't be tempted by the bait the bully uses to lure you back in!" This bait could be in the form of an insincere apology or even a gift. Once you bite the bait, you have once again allowed yourself to become a victim. Take responsibility for this pattern of being lured in to be hurt again. The fields of psychology and psychiatry have shown us that bullies and narcissists change in only a few, extremely rare cases. Character flaws tend to be lifelong. So, trust those who have consistentlyearnedyourtrust - these are your "real family."